Hypertensive heart disease is often associated with a preserved left
ventricular ejection fraction despite impaired myocardial shortening.
The authors investigated this paradox in 55 hypertensive patients (52±13
years, 58% male) and 32 age- and sex-matched normotensive control
patients (49±11 years, 56% male) who underwent cardiac magnetic
resonance imaging at 1.5T. Long-axis shortening (R=0.62), midwall fractional shortening (R=0.68), and radial strain (R=0.48) all decreased (P<.001)
as end-diastolic wall thickness increased. However, absolute wall
thickening (defined as end-systolic minus end-diastolic wall thickness)
was maintained, despite the reduced myocardial shortening. Absolute wall
thickening correlated with ejection fraction (R=0.70, P<.0001).
In multiple linear regression analysis, increasing wall thickness by 1
mm independently increased ejection fraction by 3.43 percentage points
(adjusted β-coefficient: 3.43 [2.60–4.26], P<.0001).
Increasing end-diastolic wall thickness augments ejection fraction
through preservation of absolute wall thickening. Left ventricular
ejection fraction should not be used in patients with hypertensive heart
disease without correction for degree of hypertrophy.
- Bristol Heart Institute
- Left ventricular hypertrophy
- Heart Failure
- Hypertension - general